My mother says that the daughters always come back… 

She tells me, with a kind of resigned acceptance, that when a parent is sick, it is always their female children who return home to care for them. No matter how far-flung their location, women are expected to abandon careers, social obligations, entire lives, and journey to the bedside of ailing mothers and fathers. In small towns like the one my mother calls home, women who feel their elderly parents or sick family members might be better cared for in a home or hospice are met with whispers and recriminations. “Look at her,” the neighbors hiss, “waltzing around town, and her loved one entrusted to strangers, professionals.” Women, by virtue of a supposedly inborn sensitivity, are simply required to care. Bound up with notions of maternal love and self-sacrifice, we imagine that women are built to nurse and nurture others. Even within the fields of professional caring, it is women who dominate, as nurses, healthcare assistants, or social workers. Sociologist Kate Elizabeth Huppatz has observed that “Caring is popularly considered to be a feminine practice and those who work in paid caring occupations like nursing and social work are predominantly women” (115). The connection between womanhood and caring is often naturalized, framed as an extension of the role women have traditionally played within the domestic sphere (Bowden 104). The female carer also inhabits a strangely contradictory role: she is praised for her devotion to others, but at the same time, her work is devalued, constructed as mundane “women’s work” (Porter 510).

Our understanding of what constitutes an appropriately devoted carer is also extremely rigid. In popular culture, women who abuse their positions or neglect their charges are framed as fundamentally monstrous creatures. The elderly Baby Jane Hudson (Bette Davis) is a grotesque figure who starves, beats, and tortures her wheelchair-bound sister Blanche (Joan Crawford). Jane is a hideous perversion of the good carer, presenting Blanche with luncheons comprised of dead canaries and rats. Cutting off her sister’s only means of contact with the outside world, Jane sarcastically mimics the language of the devoted nurse: “You’d better not tire yourself out using the phone anymore.” In Billy Wilder’s classic film noir Double Indemnity, the scheming femme fatale Phyllis Dietrichson (Barbara Stanwyck) is cast as utterly, irredeemably evil when it is revealed that she abused her position as a private nurse to murder her husband’s previous wife. Nurse Ratched in Ken Kesey’s One Flew Over the Cuckoo’s Nest (1962) and its 1975 film adaptation is an iconic villain because she treats the role of the nurse as an administrative, authoritarian position rather than as a maternal or nurturing one.

What Ever Happened to Baby Jane? | film by Aldrich [1962] | Britannica

Whatever Happened to Baby Jane (1962)

Even those women who are not malevolent, but simply fail to meet societal expectations that caregivers remain eternally, almost masochistically, dedicated to their charges are tormented by their perceived shortcomings. Eleanor Vance, the heroine of Shirley Jackson’s The Haunting of Hill House (1959), is less haunted by literal specters than by the guilt of having failed to tend to her chronically ill mother: “She knocked on the wall and called me … and I never woke up”. Likewise, Rachel in Stephen King’s Pet Sematary (1983) is traumatized both by her belief that she was responsible for her sister Zelda’s death and by the fear she felt towards her deformed sibling while she lived. Although she was only a child at the time, much of Rachel’s lingering guilt stems from her past failure to fully love or express tenderness for a sister who had been twisted, emotionally and physically, by spinal meningitis. Yet, while women who fail to care enough – whether through malice, fear, or exhaustion – are invariably condemned, so too are those women who care too much. Overbearing mothers who use their children’s illness as a pretext to keep them uncomfortably close are horrific, suffocating monsters. In the worst cases, this over-abundance of caring blossoms into the full-blown psychological disorder of Münchausen syndrome by proxy. Gillian Flynn’s novel Sharp Objects (2006) features an attentive mother who is later revealed to have exacerbated her daughter’s illness, deriving pleasure from the praise lavished upon her by a small community for whom she exemplifies the self-sacrificing, loving caregiver. The role of carer is a narrow one, and the mantle of the monster is reserved both for women who are excessive in their devotion and for those who appear insufficiently caring. 

Two films released within the past year feature female protagonists rendered grotesque by either an excessive desire to care or a callous refusal to attend to the wellbeing of others. Produced in 2019 and released in late 2020, Rose Glass’s intensely intimate horror film Saint Maud explores the slow psychological unraveling of a private nurse who becomes obsessed with saving the soul of her latest charge. Debuting in early 2021, J. Blakeson’s black comedy I Care a Lot centers on a protagonist who exploits her position as a court-appointed guardian to appropriate the financial assets of incapacitated senior citizens. Although these films are wildly different in tone, both of their protagonists are portrayed as monstrous due to their inappropriate approaches to caregiving. In I Care a Lot, Marla Grayson (Rosamund Pike) weaponizes the language of caring and exploits the cultural association between femininity and nurturing for financial gain. On the opposite end of the spectrum, the eponymous “Saint” Maud (Morfydd Clark) appears overly invested in the welfare of her charges, loving them too much and attempting to nourish their souls as well as their bodies. Maud’s devotion becomes increasingly repulsive over the course of the film, as her intimacy with her patient Amanda (Jennifer Ehle) takes on an obsessive character. Maud, believing that she has been chosen by God for an extraordinary martyrdom, not only feeds and dresses Amanda but happily cleans up her vomit and masochistically suffers her derision. Maud is too invested, too committed to her charge, while Marla is explicit in her disdain for those entrusted to her care.

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Marla Grayson is an amalgam of sharp edges: Her blonde bob is styled with angular precision, her suits are severe and her tongue is razor-sharp. Like many women deemed insufficiently loving, or insufficiently maternal, she is defined by a disconcerting sharpness. Good women – the kind who make good mothers or daughters or wives – possess an appealing softness. They are coded as gentle or nurturing through their flowing hair, supple bodies, and the delicate lines of their dress. Marla, by contrast, evinces a disconcerting spikiness. Her voice is deep and her features are hard. In the film’s opening sequence, she is explicit about her ambition. Juxtaposed against scenes of elderly nursing home patients being fed, entertained, and medicated, Marla’s voiceover explains her motivations and outlines her philosophy. Although she works as a court-appointed guardian for the elderly, Marla lacks compassion. Her only desire is for wealth and success. However, she is acutely aware that wealth cannot be accumulated through self-sacrifice. Rather, for Marla, success requires selfishness and is contingent upon the exploitation of others. In her introductory monologue, Marla specifically criticizes the American work ethic, the fantasy that with enough dedication even the poorest person can pull themselves up by their bootstraps and build a successful life. Marla condemns Americans for “thinking that working hard and playing fair would lead to success, and happiness”, explaining that “It doesn’t. Playing fair is a joke invented by rich people to keep the rest of us poor.” Attacking the systemic nature of wealth inequality and its reliance on the mythology of hard work, Marla advocates instead for cruelty and self-interest. 

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Marla’s venal pursuit of material gain is also positioned within a specifically gendered framework, and the viewer’s desire to read her as a villain has much to do with her refusal to perform womanhood as nurturing or loving. At the start of the film, Marla explains that there are two types of people in the world, “lambs and lions”: those who are exploited and those who exploit them. Marla is adamant in her refusal to act as a soft, tender, and ultimately vulnerable lamb. She tells the audience, “My name is Marla Grayson, and I’m not a lamb. I am a fucking lioness!” She is aware that her predatory nature is not easily reconcilable with her femininity, even if such female predators exist in the wild. Indeed, viewers and critics of the film seem to have found Marla’s coldness repulsive precisely because she is a woman. I Care a Lot teems with cruel, unlikeable, and murderous characters. Peter Dinklage’s Roman Lunyov is a sadistic, widely feared member of the Russian mob, while Dean Ericson (Chris Messina) is a deeply corrupt mafia lawyer. Other characters, such as Alexi Ignatyev (Nicholas Logan), engage in brutal, often arbitrary, acts of violence. Yet, their evil seems almost mundane, every day. It is Marla who is framed, in the film itself and in recent criticism, as truly worthy of contempt. In a review for The Detroit News, Adam Graham claims that while a “good” antihero can be an alluring figure, there is nothing appealing about the character of Marla Grayson. In contrast to characters like Tony Soprano or Walter White, whom he describes as “guys you ended up inviting into your home and rooting for even in their darkest hours,” Graham deems Marla thoroughly unlikeable. Yet, like the anti-heroes she is compared to, Marla has loved ones she seeks to protect (Eiza González’s Fran) and endeavors to renegotiate the American dream on her own terms. The discomfort critics and audiences feel when confronted by Marla’s callousness appear to stem less from the cruelty of her actions and more from her failure to inhabit the appropriately feminine role of caregiver. She is an unsettling character because she subverts, and vocally rejects, the cultural narrative that women are born carers. Within the context of the film itself, the specifically gendered nature of Marla’s monstrosity is highlighted through her interactions with Sam Rice (Damian Young), the crooked manager of a nursing home. Although Sam, like Marla, abuses and exploits his elderly charges for financial gain, he is portrayed as little more than a corrupt bureaucrat. His behavior does not invert gender norms, and as such, it is merely distasteful but never monstrous.

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Marla’s capacity to exploit those placed in her care is rendered even more disturbing by the manner in which she regularly conceals it behind a façade of compassion. In one of our first encounters with Marla, she is the middle of court case, about to be appointed the legal guardian of an elderly women. When the woman’s son objects, Marla explains that she is infinitely more qualified to care for his mother, because “caring, sir, is my job.” Here, Marla takes advantage of the societal expectation that women are natural carers and that caring, when professionalised, is women’s work. She earns the trust of those around her by weaponising the language of caregiving, exploiting the cultural narrative that women are inherently loving and self-sacrificing. Towards the end of the film, once she has achieved her longed-for wealth and status, Marla gives a television interview wearing a resplendent white suit that resembles the dress of either an angel or a nurse. When asked for the secret of her success, Marla smiles and states, “I’m just someone who cares.” It’s an easy story for the public to accept: Marla’s successful career as a professional caregiver is merely an extension, drawn out to its logical conclusion, of women’s affinity for caring. For the audience watching the film, though, Marla is rendered doubly monstrous. Her exploitation of those she professes to nurture is a subversion of woman’s “natural” role as caregiver, while her cynical, insincere deployment of that same role casts her as essentially manipulative. She is not caring but calculating. 

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Where Marla is too cold, too removed, the heroine of Saint Maud is too invested, too attached. She is excessive in her religious devotion, living the spartan life of a medieval saint and scourging her body in an expression of religious ecstasy. However, Maud is also excessive in her commitment to those she cares for. When we first meet Maud, she is a nurse named Katie. The camera finds her crouched on the floor, despondent upon losing a patient. Later, having renamed herself following a religious conversion, we learn that Maud/Katie killed the patient herself, accidentally breaking their ribs during a vigorous attempt at CPR. This briefly glimpsed piece of personal history is emblematic of Maud’s character – she simply cares too much. In fact, Maud’s caregiving is so excessive, so masochistically devoted, that it sometimes lapses into violence against both herself and others. When Maud is hired as a private nurse for a terminally ill former dancer named Amanda, she loses herself in caring for this woman. Not only does Maud care for Amanda’s body by feeding, dressing, and bathing her, but she also goes so far as to care for her soul, attempting to dissuade Amanda from promiscuous sex and atheistic abandon. Maud loses her identity in the role of caregiver, sacrificing her selfhood in her devotion to Amanda. This is an experience common to carers, who regularly perceive an intense relatedness in their relationship to those they care for. 

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Yet, while Maud, gives herself over to the role of nurse, sacrificing her own identity for Amanda’s wellbeing, her actions need not be read as a simple display of selflessness. Maud’s identity as a carer is important to her. Indeed, it constitutes the very core of her being. When the intensity of her caregiving leads to the death of a patient and her dismissal from the hospital where she had worked, Katie reinvents herself as Maud, a private nurse and committed Catholic. In doing so, these identities become intertwined, and Maud comes to believe that not only has she been chosen by God for some special purpose, but that this purpose is intimately bound up with her position as a carer. For Maud, there is no boundary separating her religious fervor from her commitment to caring. Both roles are all-consuming, excessive, and often inappropriate. And, over time, they merge into one. During their first weeks together, Amanda presents Maud with a gift: a book of paintings by the profoundly spiritual artist and poet William Blake, which she addresses to “Maud, my savior.” This delights Maud, who attempts to mimic the pose of one of Blake’s angels. In Maud’s mind, she really is an angel, a saint, a would-be martyr. Her obsessive devotion to Amanda can therefore be read as part of Maud’s deluded approach to spirituality. Saving Amanda, healing the sick, is merely one step on her path to sainthood.

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Throughout the film, Maud attempts to fulfil other criteria for sainthood alongside and often as part of her care for Amanda. Like the medieval anchoresses who sealed themselves away to live in a state of constant prayer, Maud inhabits a tiny cell-like room. She entertains ecstatic visionary experiences and enjoys an almost orgasmic connection to the Lord. Significantly, Maud’s devotion to Amanda is paralleled by acts of intense self-injury. She burns herself on a stovetop, peels off patches of her skin and walks around her small seaside town with nails embedded in her shoes. In these moments, Maud’s behaviour recalls that of medieval saints who starved their bodies and scarred their flesh in order to bring themselves closer to God. Most of these saints were women, and while caring for the sick and poor, they also refused food, cut their hair, scarred their faces and drove nails or other implements into their flesh. In his book Holy Anorexia, the historian Ralph M. Bell describes this behaviour as an attempt on the part of otherwise disempowered young women to take control of their spiritual destiny:

“The girl, that she may become more beautiful in God’s eyes, may cut off her hair, scourge her face, and wear coarse rags. To be more mindful of the Passion she may walk about with thirty-three sharp stones in her shoes or drive silver nails into her breasts. She stands through the night with arms outstretched in penitential prayer and stops eating, taking her nourishment from the host. If so much as a bean remained in Catherine of Siena’s stomach, she vomited.” (19-20)

Biographies and autobiographies describe the religiously motivated masochism of these saints: Saint Veronica would burn her hand in a firepot, wishing to burn like the martyrs; Angela of Foligno would whip herself; Saint Catherine of Siena not only starved herself but proved her devotion to the sick by drinking the pus that oozed from their bodies.

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Over the course of the film, Maud repeats variations of the phrase “Never waste you pain.” Like her medieval precursors, Maud aims to transform pain into spiritual transcendence. She injures her own body repeatedly in hopes of bringing herself closer to God. Significantly, her masochism bleeds over into her acts of caring. She sacrifices her own identity as she looks after others, losing herself in the role of nurse. Female nurses and carers are often described as “saints” or “angels”, beatified on the basis of their willingness to dedicate their lives to the sick. Maud, however, attempts to literalise this beatification. She strives for actual sainthood, scourging her own body even as she nurses Amanda’s and ultimately endeavouring to save her patient’s soul. As Maud’s delusions of sainthood solidify into full-blown psychosis, she wraps herself in a white robe (fashioned from a bedsheet) and visits Amanda in the night. When Amanda rejects her proselytizing, Maud imagines that the dying woman has been possessed by the devil and stabs her to death in a violent frenzy. As with the patient whose ribs she cracked in an attempt to save their life, Maud’s violence towards Amanda stems from an overabundance of caring. She brutalises the woman’s body in hopes of saving her immortal soul. Dazed and pale, stumbling from Amanda’s home in her white robes, Maud is a grotesque figure. She has been twisted into something monstrous through her extreme, often overbearing, commitment to caregiving. In the last moments of the film, having saved Amanda’s soul, Maud imagines that she has sprouted a set of angelic wings. Finally ready to embrace martyrdom and accept her heavenly reward, Maud walks to a beach crowded with early morning walkers. Dowsing herself in acetone, Maud sets fire to her body, her immolation serving as a last act of spectacular self-injury. Yet, while Maud imagines herself ablaze in a heavenly light and shrouded in God’s glory, the film’s final shot strips away her delusion to show the would-be saint burning in agony as onlookers scream in horror. Maud’s path to sanctity has been nothing more than a fantasy.

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Maud is undoubtedly a compelling figure. In her obsession with saving her patient’s soul, Maud twists the attributes of the good woman, the dedicated caregiver, into a horrifying parody of this role. Maud is not merely self-sacrificing, she is self-effacing and ultimately masochistic in her devotions. Her love for her those placed in care is so extreme, so all-consuming that it regularly manifests as violence. In her final act of martyrdom, she dies not only for God but for all humankind. Nevertheless, as viewers, we are neither inspired nor comforted by Maud’s dedication. She is, instead, a deeply uncomfortable reflection of extreme self-sacrifice. Maud’s death is at once the inevitable outcome of her deeply damaged psyche and a means of negating the discomfort she arises within us. If the intensity of Maud’s caring renders her monstrous, then like all monsters she must inevitably be destroyed or contained. Her abhorrence must be eliminated. Similarly, I Care a Lot also concludes with the deviant caregiver suffering a spectacularly public death while dressed in splendid white garments. Shot as she leaves a television interview, Marla dies at the hands of a man enraged by her treatment of his elderly mother. Like Maud, Marla’s story could only end in death. Her callousness and failure to care appropriately (or at all) for her charges mean that she too represents an abhorrence that must be purged from society.

The black comedy of I Care a Lot is undoubtedly a world away from the claustrophobic psychological horror of Saint Maud. Yet, both films reveal cultural anxiety about the role of caregiver. Presenting us with heroines who become monstrous through either an excess or a deficit of care, these films trouble the narrow parameters we use to define the good caregiver. These films are also profoundly uncomfortable viewing experiences because of how they subvert the cultural narrative that frames women as natural carers. Whether through Marla’s coldness or the violent intensity of Maud’s devotion, these works interrogate the pervasive belief that the inherent tenderness of women makes them more suitable for the care of others. 


Rudolph M. Bell, Holy Anorexia (University of Chicago Press, 1985)

Peta Bowden, Caring: Gender Sensitive Ethics (Routledge, 1997) 

Adam Graham, “Nothing to care about in ‘I Care A Lot’”, Detroit News

Kate Elizabeth Huppatz, “Class and career choice: Motivations, aspirations, identity and mobility for women in paid caring work”, Journal of Sociology, 46(2): 115-132. 

Sam Porter, “Women in a women’s job: the gendered experience of nurses,” Sociology of Health and Illness, 14(4): 510-527.Caroline Walker Bynum, Holy Feast and Holy Fast: The Religious Significance of Food to Medieval Women (University of California Press, 1988)